Table Of ContentEditors:
Mark D. Duncan
Lance W. Chapman
Minesh P. Shah
Series Editors:
Veeral S. Sbeth
Stanley Zasla:u
Robert Casan0Ma
• Wolters Kluwer
LIPPINCOTT
Q&A MEDICINE
LIPPINCOTT
Q&A MEDICINE
Review for Clinical
Rotations and Exams
Editors Series Editors
Mark D. Duncan, MD Veeral Sudhakar Sheth, MD, MBA,
Resident Physician FACS
Department of Medicine Director, Scientific Affairs
UCLA Medical Center University Retina and Macula Associates
Los Angeles, California Clinical Assistant Professor
University of Illinois at Chicago
Lance W. Chapman, MD, MBA Chicago, Illinois
Resident Physician
Department of Dermatology Stanley Zaslau, MD, MBA, FACS
UC Irvine Medical Center Professor and Chief
Irvine, California Urology Residency Program Director
Department of Surgery/Division of
Minesh P. Shah, MD, MPH Urology
Assistant Professor West Virginia University
Division of General Internal Medicine Morgantown, West Virginia
University of Illinois at Chicago
Chicago, Illinois Robert Casanova, MD
Assistant Dean of Clinical Sciences
Curriculum
Associate Professor of Obstetrics and
Gynecology
Texas Tech University Health Sciences
Center
Lubbock, Texas
Senior Acquisitions Editor: Tari Broderick
Product Development Editor: Amy Weintraub
Editorial Assistant: Josh Haffner
Senior Production Project Manager: Alicia Jackson
Design Coordinator: Stephen Druding
Artist/Illustrator: Jen Clements
Senior Marketing Manager: Joy Fisher-Williams
Manufacturing Coordinator: Margie Orzech
Prepress Vendor: Aptara, Inc.
Copyright © 2016 Wolters Kluwer.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced
or transmitted in any form or by any means, including as photocopies or scanned-in or other
electronic copies, or utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations embodied in critical articles and
reviews. Materials appearing in this book prepared by individuals as part of their official duties
as U.S. government employees are not covered by the above-mentioned copyright. To request
permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street,
Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com
(products and services).
9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Lippincott Q&A Medicine : review for clinical rotations and exams / editors, Mark D. Duncan,
Lance W. Chapman, Minesh P. Shah.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-9521-7 (alk. paper)
I. Duncan, Mark D., editor. II. Chapman, Lance W., editor. III. Shah, Minesh P., editor.
[DNLM: 1. Diagnosis, Differential—Examination Questions. 2. Diagnosis, Differential—
Outlines. WB 18.2]
RC71.3
616.07′5076—dc23 2015000036
This work is provided “as is,” and the publisher disclaims any and all warranties, express or
implied, including any warranties as to accuracy, comprehensiveness, or currency of the content
of this work.
This work is no substitute for individual patient assessment based upon health care professionals’
examination of each patient and consideration of, among other things, age, weight, gender, current
or prior medical conditions, medication history, laboratory data and other factors unique to the
patient. The publisher does not provide medical advice or guidance and this work is merely a refer-
ence tool. Health care professionals, and not the publisher, are solely responsible for the use of this
work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent
professional verification of medical diagnoses, indications, appropriate pharmaceutical selections
and dosages, and treatment options should be made and health care professionals should consult
a variety of sources. When prescribing medication, health care professionals are advised to consult
the product information sheet (the manufacturer’s package insert) accompanying each drug to
verify, among other things, conditions of use, warnings and side effects and identify any changes
in dosage schedule or contraindications, particularly if the medication to be administered is new,
infrequently used or has a narrow therapeutic range. To the maximum extent permitted under
applicable law, no responsibility is assumed by the publisher for any injury and/or damage to
persons or property, as a matter of products liability, negligence law or otherwise, or from any
reference to or use by any person of this work.
LWW.com
Contributors
Michael F. Ayoub, MD David Harrison, MSIV
Resident Physician David Geffen School of Medicine at UCLA
Department of Medicine Los Angeles, California
UCLA Medical Center
Los Angeles, California Ivana Jankovic, MSIV
David Geffen School of Medicine at UCLA
Natasha Cuk, MSIV Los Angeles, California
David Geffen School of Medicine at UCLA
Los Angeles, California Ashley Kita, MSIV
David Geffen School of Medicine at UCLA
Tony Cun, MSIV Los Angeles, California
David Geffen School of Medicine at UCLA
Los Angeles, California Elizabeth Lancaster, MSIV
David Geffen School of Medicine at UCLA
Elisha Garg, MSIV Los Angeles, California
David Geffen School of Medicine at UCLA
Los Angeles, California
v
Preface
The Shelf-Life series was launched in 2014 with the Pediatrics, Surgery, and
Obstetrics and Gynecology volumes leading the way. The books were designed
from the ground up with student input at each phase of the process. The
Lippincott Q&A Medicine volume builds on this foundation and takes the series
a step further with a high-yield section we feel students will find extremely
valuable. The Shelf-Life and Lippincott Q&A series are meant to help supple-
ment the student’s educational experience while on clinical rotation as well as
prepare the student for the end-of-rotation shelf and subject examination. We
are confident you will find these books challenging but an irreplaceable part
of the clinical rotation. With high quality, up-to-date content, and hundreds of
images and tables, these resources will be valuable beyond your rotation and
well into your practice.
I would like to thank Susan Rhyner, for supporting this concept from
its inception. I would like to express my appreciation to Tari Broderick,
Amy Weintraub, Catherine Noonan, Laura Blyton, Amanda Ingold, Ashley
Fischer, and Stacey Sebring, all of whom have been integral parts of the
publishing team; their project management has been invaluable. Last, but not
least, I would like to thank Monica, Sophia, and Sarina whose support before,
during, and after this project is truly treasured.
Veeral S. Sheth, MD, MBA, FACS
Stanley Zaslau, MD, MBA, FACS
Robert Casanova, MD
vi
Acknowledgments
I would like to first and foremost thank my wife Elri for all her love and sup-
port in finishing this project. I am also indebted to the Internal Medicine
faculty at UCLA, who spent countless hours teaching and mentoring me and
providing the framework for how I think about medicine. I would like to espe-
cially thank Neveen El-Farra for her mentorship and support in my career. In
addition, the motivation to pursue this project is largely a result of Donovan
Roy, who encouraged me to pursue new ideas with his full support. Lastly,
I want to thank Lance, Tari, Veeral, Minesh, Amy, and the rest of the WKH
group for believing in this idea and their guidance throughout the completion
of this project.
Mark Duncan, MD
I would like to thank Donovan Roy for providing the motivational support for
the completion of this book. It was through his guidance and connection with
students that several high-yield topics were included. Also, I want to thank
my partner Tony for his enduring support throughout this exciting venture.
Finally, this project would not have been possible without the mentorship
and unparalleled guidance of Mark, Tari, Minesh, Veeral, and Amy. This book
came to fruition as a result of a true team effort and I hope medical students
find this tremendously useful for preparing for the internal medicine shelf
examination!
Lance Chapman, MD, MBA
vii
Contents
1 Cardiology 1
2 Pulmonology 63
3 Nephrology 127
4 Gastroenterology 171
5 Endocrine and Metabolic Disorders 215
6 Infectious Diseases 253
7 Hematology and Oncology 313
8 Neurology 333
9 Rheumatology 347
10 Dermatology 367
11 General Medicine 375
viii
Contents ix
12 Practice Examination 397
13 Shelf Pearls 475
Figure Credits 535
Index 539
C H A P T E R
1
Cardiology
1 A 68-year-old man presents to the hospital with a 3-hour history of
crushing substernal chest pain. He reports that the symptoms developed
suddenly and were accompanied by sweating and nausea. The chest
pain has been getting worse, is not exacerbated by deep inspiration, and
does not radiate to his jaw or either arm. He endorses mild shortness
of breath but denies subjective fevers, chills, headache, cough, abdom-
inal pain, and diarrhea. He has a history of coronary artery disease,
hypertension, diabetes, and gastroesophageal reflux disease (GERD).
He takes aspirin, lisinopril, metformin, and omeprazole. His family
history is significant for hypertension in both parents, and his father
died of a heart attack at the age of 60. He has a 40 pack-year history of
smoking, and denies any alcohol or illicit drug use. On examination,
the patient is afebrile with a blood pressure of 150/96 mmHg, heart rate
of 89 beats per minute, respiratory rate of 18 breaths per minute, and
oxygen saturation of 97% on room air. He appears diaphoretic. There
is an S3 on cardiac auscultation, with mildly elevated jugular venous
pulsations and bibasilar rales on pulmonary examination. His dor-
salis pedis and posterior tibial pulses are diminished bilaterally, with
mild swelling around his ankles. His initial laboratory values and ECG
(Figure 1-1) are shown below.
Figure 1-1
1
